Khulna Medical College Hospital Research Articles

Results of internal fixation and anterior muscle pedicle bone grafting in old femoral neck fracture

Sixteen cases of old fracture neck femur were treated by internal fixation and anterior muscle pedicle bone grafting of rectus femoris, sartorius bone block from anterior superior iliac spine. The treatment period were from January 2000 to December 2009 at Khulna Medical College Hospital and some private hospital. Different methods of fixation and bone grafting procedure were reported. We did this procedure by open reduction and internal fixation by cannulated hip screws and muscle pedicle bone grafting. Additional cancellous bone grafting were done in every cases. Follow up period was 2 to 7 years (average 5 years). Evaluation parameter were union, non union. collapse of neck, avascular necrosis of femoral head (AVN) coxavara, shortening, pain, range of movement and functional activities and over all satisfaction of patient. The results of fracture healing rate was good (9), fair (4) and poor (3). The technique is simple, rewarding and easy access of fixation and muscle pedicle bone grafting. Bone graft was placed by making a gutter at fracture site and maintained by a screw or prolin suture. DOI: http://dx.doi.org/10.3329/bmjk.v43i1-2.13016 Bang Med J (Khulna) 2010; 43: 10-11

Syringomyelia with atypical presentation

A 50 years old male patient was admitted in Khulna Medical College Hospital with grade-III weakness of both upper limbs and grade-IV weakness of both lower limbs, marked wasting of muscles in upper back and shoulder girdle region. There was no fasciculation, no pyramidal signs and no sensory loss. All routine investigations including NCS and EMG were normal. MRI of cervical and dorsal spine revealed a large syrinx extending from the cervico-medullary junction to the sixth dorsal spine with herniation of cerebellar tonsil through foramen magnum. With these findings the case was diagnosed as syringomyelia with atypical presentation. DOI: http://dx.doi.org/10.3329/bmjk.v43i1-2.13019 Bang Med J (Khulna) 2010; 43: 21-22

Prevalence of dental caries in the primary dentition among under five children

Dental caries is the most important dental health problem in developing countries. The study aimed to estimate the prevalence of dental caries in primary dentition among under 5 years children. A simple random sampling method was used. Study population was under 5 children attending dental department of Khulna Medical College Hospital from January to June 2010. A total of 672 children were examined. The prevalence of dental caries was 44.34%. Caries prevalence was higher in the boys than the girls and it was statistically significant (P <0.05). It was also found that primary second molars were the highest carious tooth. The prevalence of dental caries among under 5 children was high. There is a need to generate awareness about oral health and the prevention of dental caries. DOI: http://dx.doi.org/10.3329/bmjk.v43i1-2.13015 Bang Med J (Khulna) 2010; 43: 7-9

Genital Tuberculosis – An Uncommon Presentation

A married women of 30 years, mother of one child, housewife was referred to out patient department of Khulna Medical College Hospital with history of blood stained vaginal discharge, secondary amenorrhoea for 3 years and evening rise of temperature and anorexia for 3 months. On speculum examination, cervix was oedematous, bright red in colour with papillary growth which bleeds on touch. She also had bilateral excavated lesion at the lowest part of the vagina close to the introitus which was red in colour with undermined edge. Visual inspection aided by acetic acid (VIA) was positive. Colposcopy guided biopsy was taken from unhealthy areas. There was extensive mottling on chest X-ary. She had high ESR, AFB+ve on sputum culture. The patient was diagnosed as a case of active pulmonary TB. Histopathological report of cervical tissue showed granulomatous lesion. Patient was given a regimen of standard anti TB drugs. After 2 weeks, during her first follow up, patient had few symptoms with regression of cervical growth and disappearance of vaginal ulcer. Patient herself stated about her wellbeing after the start of anti- TB drugs. Though cervical TB is not uncommon among genital TB (5-24%), vaginal tubercular lesion is very uncommon and concurrent pulmonary, endometrial, cervical and vaginal tuberculosis is a rare event. Careful evaluation is needed to diagnose tubercular infection in genital organs specially in GOPDs and colposcopy clinics. DOI: http://dx.doi.org/10.3329/jbcps.v30i2.11421 J Bangladesh Coll Phys Surg 2012; 30: 108-111

Apert Syndrome

Apert syndrome is a rare autosomal dominant malformation. In the recent past we encountered a boy of 16 months with fusion of both fingers and toes, dysmorphic facial features presenting with cough and respiratory distress in Khulna Medical College hospital. Considering the general paucity of cases of acrocephalosyndactyly in the Bangladeshi literature, this case demands reporting. Careful evaluation is necessary in a doubtful case to optimize the treatment.DOI: http://dx.doi.org/10.3329/bmjk.v44i1-2.10473Bang Med J (Khulna) 2011: 44(1&2) 25-27

Magnitude of cancer patients in a teaching hospital

This was an observational study carried out among all cancer patients attended at radiotherapy department of Khulna medical college hospital between January 2010 and December 2010. The study aimed to develop a primary data source for further research and improvement of patient care. Data were collected by a questionnaire. Total study population was 321 and out of them 158 was male and 163 were female. Top five organs involved with malignancies of both sexes are breast (14.64%), non-Hodgkin’s Lymphoma (1 0.59%), lung (7.79%), mouth and oral cavity (7.48%), and stomach (7.48%). This hospital-based cancer registry should be maintained to improve the treatment facilities and follow-up system.DOI: http://dx.doi.org/10.3329/bmjk.v44i1-2.10471Bang Med J (Khulna) 2011: 44(1&2) 18-24

Experience of peptic ulcer perforation over a decade in a teaching hospital of southern Bangladesh.

To determine disease characteristics, check the treatment status and compare outcome with other series. A retrospective study in a single unit of the Department of Surgery of Khulna Medical College Hospital, south west Bangladesh. After diagnosis by clinical and radiological examination, 491 patients were treated during the period July 1992 to November 2002. Two options of treatment were carried out: simple closure and peritoneal lavage in 364 cases, and 127 patients managed by non-surgical methods. mortality and morbidities. Male:female ratio was 445:46, average age 43 years. Mortality in the surgical group was 6.8% and in the non-surgical group 0.02%. Perforated peptic ulcer is prevalent even after the wide use of H2 receptor antagonists. Strict case selection for surgical and non-surgical treatment has reduced mortality. These results support the case for non-operative treatment and for conservative surgery.

Burden and outcome of human influenza in a tertiary care hospital of Bangladesh

Objective To determine the magnitude and outcome of influenza in southern part of Bangladesh and also to identify intrusion of novel influenza virus. Methods This study was conducted for two years (2008–2009) in outpatient and inpatient department of both paediatrics and medicine discipline of Khulna Medical College Hospital. Nasal and throat swab specimens were collected from each influenza like illness (ILI) case and kept together in a virus transport media and transported to international centre for diarrhoeal disease and research, Bangladesh laboratory. Influenza virus was detected by rRT-PCR including types and subtypes. Results A total of 526 patients were enrolled during the study period with the mean (SD) age of 19 (17) years. Identification of influenza virus was 14% and positive cases were mostly found in under-five children (24%). The vast majority (88%) of influenza cases were found during April to September. Virus detection rate was higher in inpatient department (IPD) (21%) than in outpatient department (12%). The dominant virus type and subtype was influenza A (87%) and H3 (49%), respectively. Type A was significantly higher than type B in causing severe illness compared to ILI ( OR=7.04, 95% CI: 2.76–18.7, P<0.01). Headache and chest indrawing was found in significantly higher proportion ( P<0.05) in influenza positive IPD cases. Among 31 hospitalized cases majority (77%) recovered completely except two cases that needed referral for additional support. Conclusions Influenza mostly affected under-five children and young adult. The peak season here was late summer and rainy season.

Puffer fish (Tetrodotoxin) poisoning: an analysis and outcome of six cases

On 24 July 2005, six members of a single family were admitted to the Medicine and Pediatrics Department of Khulna Medical College Hospital, Khulna, Bangladesh, with a history of ingestion of puffer fish. All patients developed toxic manifestations. The cases were clinically analysed with successful outcomes.

Mortality in Perforated Peptic Ulcer Patients After Selective Management of Stratified Poor Risk Cases

Perforated peptic ulcer disease continues to inflict high morbidity and mortality. Although patients can be stratified according to their surgical risk, optimal management has yet to be described. In this study we demonstrate a treatment option that improves the mortality among critically ill, poor risk patients with perforated peptic ulcer disease. In our study, two series were retrospectively reviewed: group A patients (n = 522) were treated in a single surgical unit at the Dhaka Medical College Hospital, Dhaka, Bangladesh during the 1980s. Among them, 124 patients were stratified as poor risk based on age, delayed presentation, peritoneal contamination, and coexisting medical problems. These criteria were the basis for selecting a group of poor risk patients (n = 84) for minimal surgical intervention (percutaneous peritoneal drainage) out of a larger group of patients, group B (n = 785) treated at Khulna Medical College Hospital during the 1990s. In group A, 479 patients underwent conventional operative management with an operative mortality of 8.97%. Among the 43 deaths, 24 patients were >60 years of age (55.8%), 12 patients had delayed presentation (27.9%), and 7 patients were in shock or had multiple coexisting medical problems (16.2%). In group B, 626 underwent conventional operative management, with 26 deaths at a mortality rate of 4.15%. Altogether, 84 patients were stratified as poor risk and were managed with minimal surgical intervention (percutaneous peritoneal drainage) followed by conservative treatment. Three of these patients died with an operative mortality of 3.5%. Minimal surgical intervention (percutaneous peritoneal drainage) can significantly lower the mortality rate among a selected group of critically ill, poor risk patients with perforated peptic ulcer disease.

Utility of misoprostol for labor induction in severe pre-eclampsia and eclampsia.

To determine the effectiveness and safety of misoprostol in severe pre-eclampsia and eclampsia patients with unripe cervix. A prospective observational study was carried out in 135 severe pre-eclampsia and eclampsia patients who required termination of pregnancy at the Department of Obstetrics and Gynecology, Khulna Medical College Hospital, Khulna, Bangladesh during January 2002 to October 2003. Fifty micrograms of misoprostol was used every 4 h in cases of unripe cervix (Bishop score < or = 6) in severe pre-eclampsia and eclampsia patients. Maternal and perinatal outcome as well as any complications were recorded. In severe pre-eclampsia and eclampsia patients vaginal delivery occurred in 79.3 and 80.5% of cases, and cesarean section was performed in 20.6 and 19.4% of cases, respectively. The maximum required responsive dose was 50-150 microg. Oxytocin augmentation was required in 29.3 and 35% of cases, respectively. Induction to delivery time was median 8 h, interquartile ranges 4.2-8.2 h in the severe pre-eclampsia group, and median 9 h, interquartile ranges 6.8-12.5 h in the eclampsia group, and average hospital stay was 3.4 +/- 1.8 and 3.7 +/- 1.7 days, respectively. The only maternal complications were hyperstimulation which occurred in 6.8 and 5.1% of cases, respectively. Neonatal death occurred in five (11.3%) and eight cases (12.1%), respectively. Intravaginal misoprostol is well tolerated and very effective for the induction of labor in severe pre-eclampsia and eclampsia patients with unripe cervix.

Incidence of Congenital Hypothyroidism in the Newborn of A Tertiary Hospital in Southern Bangladesh

Background: Congenital hypothyroidism is the commonest preventable cause of mental retardation. It is more prevalent in endemic goiter regions like Bangladesh. But magnitude of the problem has not been studied at national level.Objective: To detect the incidence of congenital hypothyroidism among the newborn delivered in Khulna Medical College Hospital in southern part of Bangladesh and to rationalize the development of neonatal screening program.Methodology: All the living newborns delivered between Oct '01 to June ‘05 in Khulna Medical College Hospital were included in the study. After taking the relevant information from mother, cord blood sample were collected from the newborn within 24 hours of birth and kept in freezer. At the end of collection of each two month, the lot of blood sample was sent to the laboratory of Institute of Nuclear Medicine, Dhaka for radioimmunoassay of TSH. Potential cases with TSH value above 10 MIU/L were recalled for thyroid function test for confirmation of diagnosis.Results: After discarding unsatisfactory samples, 1353 samples were assayed for TSH. Among the study population 88.2% hailed from Khulna district and the rest of the cases came from neighboring districts. Male to female ratio was 1.2:1. Regarding the birth weight 33.4% babies were of low birth weight. TSH above 10 MIU/L were found in 35 babies among whom one baby was hypothyroid and the other member of the twin was also hypothyroid although the TSH level was below 10 MIU/L. Thus incidence of congenital hypothyroidism was 1.5 per thousand living newborn among the studied cases.Conclusion: The incidence of congenital hypothyroidism in southern part of the country is quite high in relation to global incidence. Although this is not the national picture but the high figure is alarming. So, neonatal screening program should be implemented as soon as possible to find out the real case burden in the community and thereby to take care of them and reduce the number of mentally retarded children in our country. Key words: Congenital hypothyroidism; neonatal screening; mental retardation. DOI: 10.3329/bjch.v29i3.6186 Bangladesh J Child Health 2005; Vol 29 (3): 88-92

Incidence of Common Transfusion Transmitted Diseases Among Blood Donors

Transfusion transmitted diseases are one of the major health problem in Bangladesh. This study was carried out among 12,270 voluntary and directed donors in the transfusion medicine department of Khulna Medical College Hospital (KMCH), a teaching hospital of southern Bangladesh during the period from 1st July 2007 to 30th June 2008 to see the incidence of HIV, HCV, HBV, Syphilis &amp; Malaria. All were voluntary and relative/directed donors. No professional donors had taken part in this donation system. Blood samples were collected in sterile dry plain test tube after predonation consent. Serum of each donor was collected by proper centrifugation within 6 hours of collection. Tests of all the samples were done within 24 hours of collection. The methods used were latex agglutination Immunochromatographic test (ICT) and reconfirmed by ELISA techniques. For malaria thick and thin film studies under microscope were done. On analyzing the results, 171 (1.39%) were found positive for HBsAg, 03 (0.024%) were positive for anti HCV, 01 was positive for anti HIV (0.008%). None found positive for Malarial parasite (MP) none were reactive for RPR test. Donation from professional blood donors are completely stopped in the transfusion medicine unit of KMCH. Mandatory screening of donated blood should be done for HIV, HBV, HCV, Syphilis and Malaria to reduce their transmission by transfusion. Key Words: Transfusion transmitted diseases, Blood donors. doi: 10.3329/jafmc.v5i1.2840 JAFMC Bangladesh. Vol 5, No 1 (June) 2009 pp.4-6

Congenital Hypothyroidism in the Southern Bangladesh

Congenital hypothyroidism is the commonest preventable cause of mental retardation. It is more prevalent in endemic goiter regions like Bangladesh. But magnitude of the problem has not been studied at national level. This study was done to detect the frequency of congenital hypothyroidism in southem part of Bangladesh &amp; to develop neonatal screening program. All the living newborns delivered between Oct 01 to June 05 Khulna Medical College Hospital were included in the study, After taking the relevant information from mother, cord blood sample were collected from the newborn within 120 hours of birth and kept in freezer. At the end of collection of each two months, the lot was sent to the laboratory of Institute of Nuclear Medicine, Dhaka for radioimmunoassay of TSH. Potential cases with TSH above 10 MIU were recalled for thyroid function test for confirmation of diagnosis. Fifteen hundred samples were collected in total during 45 months of study. One forty seven unsatisfactory samples were discarded; thereby 1353 samples were eventually assayed for TSH. Among the study population 88.2% hailed from Khulna district and the rest of the cases came from neighboring districts. Male to female baby ratio was 1.2:1. Regarding the birth weight 33.4% babies were low birth weight. TSH above 10 was found in 35 babies among whom one baby was hypothyroid and the other member of the twin was also hypothyroid although the TSH level was below 10. None of newborn had TSH level above 20. Thus frequency of congenital hypothyroidism was 1.5 per thousand living newborn. Congenital hypothyroidism in southern part of the country is quite high in relation to global incidence. Although this is not the national picture but the high figure is alarming. Therefore neonatal screening program should be implemented as soon as possible to reduce the number of mentally retarded child. doi: 10.3329/taj.v21i1.3212 TAJ 2008; 21(1): 18-22

Pattern of ABO and Rhesus(Rh) Blood Group Among Blood Donors

This study was carried out among the blood donors attending the Blood TransfusionDepartment of Khulna Medical College Hospital. Both ABO and Rhesus (Rh) blood grouping wasdone to see the pattern of ABO and Rh blood group among them. Maximum blood donors werebetween age group 18-37 years. Among the donors maximum were male 12105 (94.73%). Male:female ratio was 18:1. Among them B+ve was found 4286 (33.54%), B-ve was 127 (5.0%), O+vewas 4091 (32.02%), O-ve was 131 (1.03%), A+ve was 3014 (23.59%), A-ve was 74 (0.58%), AB+vewas 1019 (7.98%), AB-ve was 37 (0.29%). Overall total Rh positive blood group were 12410(97.11%) and total negative blood group were 369 (2.89%).doi: 10.3329/taj.v15i2.3910TAJ December 2002; Vol.15(2): 68-70